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Article

Whose Decision Is It Anyway? Men’s Perceptions of Women’s Decision-Making Autonomy in Maternal and Child Health in Western Kenya

by
Robsan Tura
1,* and
Nema C. M. Aluku
2
1
Minnesota Department of Health, St. Paul, MN 55164, USA
2
Africa Community Leadership and Development, Nairobi P.O. Box 24619, Kenya
*
Author to whom correspondence should be addressed.
Soc. Sci. 2025, 14(8), 452; https://doi.org/10.3390/socsci14080452
Submission received: 23 May 2025 / Revised: 15 July 2025 / Accepted: 18 July 2025 / Published: 23 July 2025
(This article belongs to the Section Gender Studies)
Versions Notes

Abstract

Women’s decision-making autonomy is widely recognized as a critical determinant of maternal, newborn, and child health (MNCH). However, prevailing measures often conflate genuine autonomy with decisions made within traditional gender roles, risking an overstatement of women’s empowerment. This study examines the extent to which reported female decision-making autonomy reflects authentic agency versus role-based compliance in a patriarchal context. A cross-sectional study was conducted among 280 male household heads in Kakamega County, Kenya, whose partners were pregnant or recently postpartum. Using multi-stage cluster sampling and structured interviews, men reported on household and MNCH decision-making and their rationales, categorized as gender-role conformity, belief in gender equality, or other reasons. Although 40.4% reported that their partners made decisions independently, only 11.4% attributed it to a belief in women’s equality; 28% framed it within traditional gender roles. Men were over four times more likely to perceive women’s decisions as role-based than autonomous (AOR = 4.40; 95% CI: 2.48–5.78). Younger men (18–34) were more likely to report female decision-making (AOR = 5.54; 95% CI: 5.08–7.27), without necessarily endorsing egalitarian norms. Findings highlight the urgent need for gender-transformative MNCH interventions that move beyond surface-level autonomy to address deeper structural inequities.

1. Introduction

The global discourse on maternal, newborn, and child health (MNCH) increasingly recognizes women’s decision-making autonomy as a critical determinant of improved health outcomes. Women’s decision-making autonomy—defined here as the ability to participate meaningfully in health-related decisions free from coercion (Woldemicael and Tenkorang 2010; Ahmed et al. 2019)—has been linked to greater use of essential services such as antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC) (Alam et al. 2025; Dickson et al. 2021; Gebeyehu et al. 2022; Story and Burgard 2012; Imo 2022; Tura et al. 2020). In this study, autonomy refers to cases where men reported their partners made the final decision; this does not imply unilateral action. Rather, we analyze men’s explanations to assess whether decision-making reflects empowered agency or traditional gender roles. Across sub-Saharan Africa, women who participate actively in healthcare decisions are 34% more likely to attend four or more ANC visits (Mathur et al. 2024). Similar patterns are observed in Indonesia and Bangladesh, where higher autonomy correlates with 70% and nearly 100% increases in ANC attendance, respectively (Rizkianti et al. 2020; Haque et al. 2012; Rahman et al. 2021). Beyond maternal service use, decision-making autonomy also positively influences child health outcomes, including improved vaccination rates, better nutritional status, and lower infant mortality (Kabir et al. 2020; Lu et al. 2021; Rahman and Saim 2015; Adhikari and Sawangdee 2011).
While empirical evidence supports the link between women’s autonomy and improved MNCH indicators, the relationship is complex and context-dependent. Studies occasionally report contradictory findings influenced by variations in cultural, economic, and social conditions (Fotso et al. 2009). These discrepancies underscore the importance of situating autonomy within broader structural and gendered contexts, rather than treating it as a uniform concept across settings. Promoting women’s autonomy remains critical not only for enhancing MNCH outcomes but also for advancing gender equity, particularly where restrictive gender norms persist.
Despite growing recognition of women’s decision-making autonomy as a key factor in health outcomes, significant conceptual and methodological limitations remain. A persistent issue is the conflation of decision-making within traditionally prescribed “women’s domains”—such as childcare, nutrition, and household expenditures—with broader indicators of authentic agency (Gebeyehu et al. 2022; Haque et al. 2021; Mwanzia 2015). In patriarchal contexts, these domains are socially constructed spaces where limited female influence is permitted, masking conformity to gender norms as autonomy (Bourdieu and Nice 2002). Bourdieu’s theory of social reproduction suggests that empowerment within constrained domains often reflects adherence to traditional expectations rather than genuine self-determination. Similarly, Butler’s concept of gender performativity highlights how agency is enacted within societal constraints, creating the appearance of decision-making autonomy while reinforcing existing power structures (Butler 2011). Connell’s analysis of hegemonic masculinity further explains how societal norms legitimize and restrict women’s spheres of influence, shaping their decision-making capacity (R. W. Connell 2005; Connell and Messerschmidt 2005).
Feminist critiques argue that much of the existing autonomy research inadvertently homogenizes women’s experiences, often overlooking distinct sociocultural dynamics that shape agency in specific contexts (Mohanty 2003). Measuring decision-making without critically examining the surrounding social structures risks obscuring women’s marginalization and misrepresenting compliance with patriarchal expectations as authentic empowerment (Kabeer 1999; Alsababha et al. 2024; Walby 1991; Osamor and Grady 2018). Patriarchal systems often limit women’s influence to domestic spheres, where apparent decision-making authority may conceal underlying inequalities (Osamor and Grady 2018).
These methodological limitations have serious consequences for MNCH research and practice. First, they undermine the validity of findings by masking power asymmetries and overestimating gender equity (Harding 1986; Malhotra and Schuler 2002). Second, they reinforce traditional gender stereotypes by framing women’s agency primarily within domestic and caregiving roles, which can misguide policy and program design (Dean 2011). Third, they compromise predictive validity for substantive gender equality, as research conflating socially prescribed decisions with genuine autonomy may produce spurious correlations with health outcomes (G. M. Alexander et al. 2021; M. Alexander et al. 2016; Mensah 2023). For example, a woman making decisions about child feeding under social expectations may still lack broader autonomy over economic resources, mobility, or healthcare for herself.
Furthermore, the lack of contextual sensitivity limits the generalizability of findings. Gender norms and socially acceptable domains for women’s decision-making vary significantly across cultures and over time (Ortner 1974). Without analytically disentangling traditional role compliance from true agency, studies risk misinterpreting women’s lived experiences and obscuring pathways toward genuine empowerment. The complexity of “joint decision-making” also remains underexplored. Genuine joint decision-making requires intentionality, equality, and freedom from coercion, conditions often absent in patriarchal settings (Osamor and Grady 2018).
R. W. Connell’s (2005) gender order theory provides a useful lens for understanding how symbolic, structural, and interpersonal relations systematically limit women’s substantive autonomy. Hegemonic masculinity normalizes male dominance in household and healthcare decisions, further entrenching gender inequities (Connell and Messerschmidt 2005). Even where women appear to have decision-making capacity, gender role perceptions among male partners, healthcare providers, and broader society often constrain their autonomy (R. Connell 2016; Dudgeon and Inhorn 2004; Peneza and Maluka 2018; Upadhyay et al. 2014a). Cross-cultural studies illustrate the persistence of these constraints, showing that women’s reported autonomy often remains confined to caregiving and domestic spheres, with limited influence over critical health and financial decisions (Mabsout and van Staveren 2010; Mumtaz and Salway 2009; Shroff et al. 2011).
This study seeks to challenge conventional understandings and measurements of women’s decision-making autonomy in MNCH research (Gebeyehu et al. 2022; Pratley 2016) by critically examining the gap between reported autonomy and authentic agency. Through an analysis of male partners’ perceptions of why women make decisions independently, it explores whether perceived autonomy reflects genuine empowerment or a performance of traditional gender roles. By applying theoretical frameworks such as Bourdieu’s social reproduction and Butler’s gender performativity, the study deepens academic insight into how autonomy is constructed, offers practical implications for designing interventions that foster real agency for women, and provides actionable, context-sensitive guidance for developing gender-transformative policies that promote substantive equality in health and household decision-making.

2. Materials and Methods

2.1. Study Design, Participant Selection, and Recruitment

This research was conducted in Kakamega County, Western Kenya, chosen for its diverse social and cultural gender norms influencing MNCH. The county, comprising approximately two million residents distributed across 12 sub-counties, provides an ideal context for examining variations in men’s perception of gender roles as it related to MNCH (Harrington et al. 2016; Mangeni et al. 2014; Ongolly and Bukachi 2019; Onyango et al. 2010). Participants included men either married to or cohabiting with female partners who were pregnant or had given birth within the last 12 months. This timeframe was selected to reduce recall bias and because recent pregnancy or childbirth anchors decision-making (the variable of interest) within a maternal and child health context.
A cross-sectional design with multi-stage cluster sampling was employed. The sample strategy was executed in collaboration with the Kenya National Bureau of Statistics following country’s Demographic and Health Survey sampling strategy to enhance representativeness. First, 10 enumeration areas (EAs) were randomly selected from 56 available, proportionally distributed across all 12 sub-counties to include both rural (six EAs) and urban (four EAs) settings. Subsequently, comprehensive household listings within selected EAs were obtained from the local administrators from which random sampling of 280 households was drawn. Within each household, eligible male household heads meeting the inclusion criteria were interviewed. The sample size was determined considering a design effect of 2.0, with 80% statistical power and a 5% significance threshold. Expected male engagement in MNCH (26.2%) was informed by prior local research (Kiptoo and Kipmerewo 2017).

2.2. Measures

Outcome Variable: Women’s independent decision-making autonomy. The primary outcome was women’s independent decision-making, as reported by male respondents. Respondents identified who primarily made decisions across several domains, including family planning, maternal healthcare, major and minor household purchases, education, and health expenditures. Responses were dichotomized: decisions made solely by women were coded as ‘1’, and decisions made solely by men were coded as ‘0’. Instances of joint decision-making were excluded from analysis due to ambiguity regarding the extent of women’s substantive autonomy (explained in the Section 1).
Primary Predictor Variable: Perceived reasons for women’s decision-making. Male respondents who reported women as independent decision-makers were further asked to specify the perceived reason for this decision-making autonomy. Common keywords and phrases identified in the responses included: “That is a woman’s job”, “It is her responsibility”, “No particular reason”, “Women decide about food”, “She is capable”, “We are equal”, “She can decide for herself”, “I trust her judgment”, and “It just happens that way”, among others. Responses were categorized into three groups: (1) decisions associated with traditionally defined “women’s domains”, (2) recognition of women’s equality and independent decision-making capabilities, and (3) other or unspecified reasons. This categorization allowed for a nuanced examination of male perceptions regarding the motivations behind women’s independent decision-making and the underlying gender role assumptions.
Covariates: The analysis adjusted for key sociodemographic characteristics, including respondents’ educational attainment, household wealth (measured using a principal component analysis of asset ownership), age, family size, and ethnicity.

2.3. Data Collection

Data were collected using structured, interviewer-administered surveys implemented electronically via CommCare software (V. 2.49) on handheld devices. Interviewers and supervisors received comprehensive training covering ethical considerations, interviewing techniques, digital data collection, and cultural sensitivity. The survey questionnaire was pilot tested in one of the study communities. To ensure effective communication and accurate data collection, the questionnaire was administered in the local language, Luhya. A pilot study involving 10% of the intended sample (28 participants) facilitated survey tool refinement for cultural appropriateness and clarity. Ethical approval was granted by the University of Iowa Institutional Review Board (ID #202010039) and the Kenya National Commission for Science, Technology, and Innovation (NACOSTI). Participants provided oral informed consent prior to participation.

2.4. Data Analysis

Initial analyses involved descriptive statistics for all measured variables. Binary logistic regression was then conducted to examine the association between women’s independent decision-making autonomy and men’s gender role perception (stated reasons for autonomous female decision-making), adjusted for sociodemographic covariates. Respondents who indicated that their female partner made independent decisions were presented with an open-ended follow-up question, asking them to explain, in their own words, why they believed she made those decisions independently. All open-ended responses were systematically reviewed and coded into one of three pre-defined categories: (1) Traditional “Women’s Domain”—decisions typically assigned to women by social norms; (2) Recognition of Equality/Capability—explicit belief in women’s equal rights or abilities; and (3) Other/Unspecified Reasons—responses that did not clearly fit the above categories or were ambiguous. In cases where responses could align with more than one category, coders prioritized the most clearly stated rationale. When multiple themes were present, coders discussed and identified the primary emphasis. For example, if a response referenced both tradition and ability, the coding decision was based on which rationale was more prominent. Responses that remained ambiguous or mixed after discussion were categorized as Other/Unspecified. All analyses were conducted using Stata version 16.1.

3. Results

In this study, male respondents reported who made independent decisions—themselves or their female partners—and explained why they believed these decisions were made by themselves or their female partners. Table 1 shows the descriptive statistics for the primary predictor and control variables by the perceived reason for independent decision-making. Among the 105 men (37.6%) who reported making independent decisions, the predominant justification was that decision-making was inherently a man’s domain (42.2%), with a relatively smaller proportion reporting that they made independent decisions because women were incapable of making such decisions (6.0%). Conversely, 113 men (40.4%) stated that their female partners made independent decisions, but the vast majority attributed this to the belief that women made independent decisions because matters were traditionally within women’s domain (27.9%). Only 11.4% of respondents reported women’s decision-making as a reflection of equality and capability. Joint decision-making was reported by 62 men (22.0%), with mixed reasons provided—some citing equal participation, while others saw it as a practical arrangement without challenging gender norms.
Younger men (18–24 years) more frequently acknowledged women’s decision-making in certain matters, with 6.1% attributing it to gender equality. However, in older age groups (35–49 and 50+ years), men were more likely to justify their own independent decision-making as a male prerogative (26.1% and 26.4%, respectively). At the same time, they also upheld traditional gender roles by assigning specific decisions to women while not considering these decisions as reflective of broader autonomy. The perception of decision-making authority varied across ethnic groups. Among Luhya men (n = 256), 55.4% reported that their partners made independent decisions because these decisions were seen as women’s responsibilities, not because of equality. At the same time, 64.3% justified men’s independent decision-making as their (men’s) domain. Among men from other ethnic backgrounds (n = 24), a smaller percentage (6.8%) assigned decision-making to women based on gendered responsibilities, and only 6.1% expressed the belief that decision-making is a man’s role.
Men from small households (1–3 members, n = 71) more evenly attributed independent decision-making to both themselves and their partners, with 18.6% stating that women made decisions as part of their domain, and 18.9% asserting men’s independent decision-making. In medium-sized households (4–6 members, n = 141), the perception of male-dominated decision-making increased (36.1%), while a significant proportion of men (30.7%) still assigned women’s independent decision-making to traditional gender roles rather than autonomy. Among men in large households (7+ members, n = 68), the gap narrowed somewhat, but gendered role assignment remained prevalent. Education level shaped perceptions of decision-making autonomy. Among men with no formal education (n = 11), women’s decision-making was almost exclusively attributed to traditional roles (3.4%), while men’s independent decision-making was justified as their (men’s) responsibility (2.1%). Among those with less than a high school education (n = 172), men were more likely to report their own independent decision-making power (43.9%) while also assigning women’s decisions to predefined roles (34.6%). In contrast, men with higher education (associate degree or more, n = 59) more frequently recognized joint decision-making, but this did not necessarily translate into an explicit endorsement of gender equality.
Religious affiliation played a role in shaping perceptions of gendered decision-making. Among Protestant men (n = 177), 40.0% reported that women made independent decisions because those decisions were female responsibilities, while 44.3% justified male independent decision-making as a man’s role. Similar trends were observed among Catholics, while Muslim and traditionally religious participants were more likely to perceive men as the primary decision-makers and women’s independent decisions as role-based rather than autonomy-driven. Across different wealth categories, perceptions of decision-making authority remained relatively stable. Among low-income participants (n = 95), 19.6% stated that their partners made independent decisions based on societal role expectations, while 24.3% justified their own decision-making as a male responsibility. Middle-income (n = 92) and high-income (n = 93) men reported similar distributions, suggesting that economic status had less influence on attitudes toward gendered decision-making than other social factors.
Table 2 presents the association between women’s independent decision-making and men’s perceptions of gender roles (reason why women made independent decisions), adjusting for demographic and socioeconomic factors. Men who perceived that women’s independent decision-making was due to the decision being part of women’s domain were significantly more likely to report that their female partners made independent decisions (AOR = 4.40, 95% CI: 2.48–5.78, p < 0.001) compared to those who viewed women as equal and capable of decision-making. Conversely, when men cited “some other reasons” for women’s independent decision-making, the likelihood was lower (AOR = 0.31, 95% CI: 0.07–1.34, p = 0.12), though this finding was not statistically significant. Compared to the reference group (men aged 50+ years), younger men were significantly more likely to report that their partners made independent decisions. The likelihood was highest among men aged 25–34 years (AOR = 8.52, 95% CI: 2.41–9.15, p = 0.01), followed by those aged 18–24 years (AOR = 5.54, 95% CI: 5.08–7.27, p < 0.001), and 35–49 years (AOR = 4.42, 95% CI: 2.02–9.69, p < 0.001).
Compared to men with higher education (associate degree or more, reference category), those with no formal education (AOR = 2.23, 95% CI: 0.17–2.78, p = 0.53) and less than high school education (AOR = 1.60, 95% CI: 0.61–4.21, p = 0.34) had higher odds of reporting that their partners made independent decisions, but the confidence intervals were wide and the p-values were not statistically significant. Similarly, those with high school education (AOR = 1.13, 95% CI: 0.32–4.05, p = 0.84) had no meaningful difference from the reference category. Religious background showed varying but mostly non-significant associations with women’s independent decision-making. Compared to Protestants (reference group), men of Muslim faith (AOR = 2.95, 95% CI: 0.72–12.12, p = 0.13) had the highest odds of reporting women’s independent decision-making, though this was not statistically significant. Similarly, Catholics (AOR = 1.54, 95% CI: 0.57–4.17, p = 0.39) and those practicing traditional religions (AOR = 1.11, 95% CI: 0.29–4.14, p = 0.88) showed no significant differences from Protestants.
Household size was moderately associated with perceptions of women’s independent decision-making. Compared to small households (1–3 members, reference group), men from medium-sized households (4–6 members, AOR = 0.52, 95% CI: 0.23–1.27, p = 0.15) were less likely to report that their partners made independent decisions, though this result was not statistically significant. Similarly, men in large households (7+ members, AOR = 0.82, 95% CI: 0.29–2.30, p = 0.71) had slightly lower odds, but with no strong evidence of a meaningful association. Economic status did not significantly influence men’s perceptions of their partners’ independent decision-making. Compared to those in the low-income group (reference category), men in the middle-income category (AOR = 0.81, 95% CI: 0.34–1.92, p = 0.63) and high-income category (AOR = 1.04, 95% CI: 0.41–2.68, p = 0.92) showed no meaningful differences. This indicates that financial standing alone does not appear to drive changes in men’s perceptions of women’s decision-making roles.

4. Discussion

This study critically examines how men’s perceptions of gender roles is associated with women’s independent decision-making autonomy in MNCH and household matters. While a growing body of evidence links women’s decision-making to improved health outcomes, our findings highlight a critical distinction—women’s independent decisions are often framed not as a reflection of gender equality but rather as responsibilities assigned to them by societal norms. Men in our study were 4.4 time more likely to justify women’s independent decision-making as a function of traditional gender roles rather than genuine autonomy. Only 11.4% of men perceived their female partners’ independent decisions as reflecting equality and capability, while nearly three times as many (27.9%) attributed them to societal expectations that deemed certain decisions as inherently the “women’s domain”. This reinforces a crucial insight: what appears to be decision-making freedom on the surface may actually be the reinforcement of traditional roles rather than a transformation toward gender equity.

4.1. Gendered Decision-Making: Independence Without Autonomy

A central finding of this study is that men predominantly justified women’s independent decision-making as being part of the “women’s domain” rather than as a reflection of equality and capability as evidenced by the fact that men were over four times more likely to attribute women’s independent decision-making to traditional role expectations rather than gender equity. The findings challenge the simplistic assumption that women’s independent decision-making inherently equates to autonomy or empowerment. True autonomy implies not just the ability to make decisions but the freedom to do so without societal constraints dictating which decisions are “acceptable” for women to make. In patriarchal settings like the study context, women’s decision-making remains circumscribed by pre-assigned gender roles rather than reflecting an expanded agency across all aspects of household and health-related decisions. For instance, consistent with previous evidence, decisions related to child health, food preparation, and minor household expenditures were more likely to be assigned to women, but not because men saw them as capable decision-makers and equity—rather, because these were areas already deemed “appropriate” for women (Flagg et al. 2014; Mkandawire et al. 2022; Wang et al. 2014). Conversely, men retained control over major financial decisions and healthcare utilization, areas where their authority was seen as a necessity. This aligns with available evidence showing that women’s role in decision-making often extends only to matters that do not threaten male authority and decisions considered more consequential—such as those regarding finances, land, or long-term planning—continue to be dominated by men (Alemayehu and Meskele 2017; Allendorf 2007; Bose et al. 2022; Connell and Messerschmidt 2005; Goli and Pou 2014; Tanywe et al. 2025). This underscores the need to differentiate functional independence within gendered domains from genuine shifts in power dynamics. This distinction is critical because it suggests that even when women make independent decisions, they do so within the confines of responsibilities assigned to them by societal norms, rather than out of personal agency or changing gender dynamics.
Men’s responses also revealed a persistent adherence to patriarchal structures, particularly among older age groups. Men aged 35 and above were significantly more likely to justify their own independent decision-making as a male prerogative. However, younger men (18–34 years) were more likely to acknowledge women’s role in decision-making—though this should not be mistaken as a shift toward gender equality. The increased likelihood of younger men reporting women’s decision-making does not necessarily indicate changing attitudes toward gender norms, but rather a growing recognition of women’s role within pre-defined boundaries. This raises important questions: are younger men becoming more supportive of women’s autonomy, or are they simply adapting to societal shifts while still maintaining underlying patriarchal beliefs? Emerging studies suggest that younger men may appear more accepting of women’s decision-making but still uphold patriarchal structures in other domains. For instance, research has shown that while younger men may support women’s role in household-level decisions, they may resist female participation in economic or political decision-making (Eze et al. 2025; Kilgallen et al. 2025; Miller 2020). Thus, further qualitative exploration is needed to determine whether younger men’s higher reporting of women’s decision-making is indicative of evolving gender norms or merely reflects pragmatic adjustments within traditional frameworks in Western Kenya.
The study findings show that neither education nor wealth status showed a strong or significant association with men’s perceptions of women’s independent decision-making. While, in general, higher education is often assumed to foster more egalitarian gender norms (Giani et al. 2022), our findings suggest that deeply ingrained cultural perceptions of gender roles are not easily disrupted by formal education alone. Even among men with higher levels of education, the attribution of decision-making to the “women’s domain” remained prevalent. This echoes broader global evidence showing that education alone does not automatically lead to shifts in gender attitudes unless curricula and societal norms explicitly challenge patriarchal ideologies (Du et al. 2021; Malhotra et al. 2019; Malhotra and Schuler 2002; Rivera-Garrido 2022; Upadhyay et al. 2014b; Yücetas and Carol 2024; Zhang and Zhu 2024). Socialization within families, communities, and religious institutions likely plays a stronger role in shaping gender perceptions than individual educational attainment alone (Carter 2014; Rutledge and Abrams 2023; UNICEF 2020; Yang and Gao 2021). This suggests that advancing the global gender equality agenda requires researchers to pivot toward designing and rigorously evaluating intervention programs specifically aimed at promoting men’s adoption of egalitarian gender norms (Zhang and Zhu 2024). Such interventions hold potential for accelerating progress, as shifting men’s attitudes is critical to achieving sustained gender transformation. Recent studies by scholars emphasize that without targeted efforts, deeply entrenched gender inequities may persist or evolve only superficially (Dhar et al. 2022; Hara and Rodriguez-Planas 2023). Therefore, models that explicitly engage men, address harmful masculine norms, and promote gender-equitable behaviors, represent an essential next step (Galvin et al. 2023; Hill and Megson 2020; Hillenbrand et al. 2023; Hook et al. 2021; Lorist 2020; Luyt and Starck 2020; McInerney and Burrell 2023; Panggabean and Gracia 2023; Silberschmidt 2011; Tatah and Ndakeyo 2023; Thompson et al. 2020).
While joint decision-making was reported by 22% of men, it remains unclear whether this reflects true partnership or a symbolic role for women within a still male-dominated structure. Previous research suggests that joint decision-making is often a practical compromise rather than an equal power dynamic (Osamor and Grady 2018). In many cases, women’s participation in decisions may be superficial, where their input is sought but the final authority still rests with men. This highlights the need to move beyond simply measuring whether decisions are made jointly and instead investigate the power dynamics underlying these decisions.

4.2. Beyond Surface-Level Autonomy—Toward Genuine Gender Transformation

The findings from this study underscore a critical need to rethink how we interpret women’s decision-making autonomy. The mere presence of independent decision-making does not equate to gender equality. Instead, we must ask: Are women making decisions because they are recognized as equal and capable, or simply because society has assigned those decisions to them as part of their gender role? The study reveals that in many cases, women’s decision-making remains confined to predefined domains rather than representing a true shift in power dynamics. The fact that men overwhelmingly justified women’s decisions as part of their “natural” responsibilities—rather than as a reflection of their ability to make independent choices—suggests that what we are witnessing is not autonomy, but the reinforcement of traditional roles. The findings from this study have important implications for gender-transformative approaches.

4.3. Redefining Decision-Making Autonomy in MNCH Interventions

Many gender-focused interventions emphasize increasing women’s decision-making. However, this study highlights the need to go further: policies must not only encourage decision-making but also challenge the norms that define which decisions women are “allowed” to make. Health programs should integrate critical discussions on gender norms with both men and women, ensuring that decision-making is recognized as a function of ability rather than gender.

4.4. Engaging Men in Gender Transformative Approaches

While this is not a new concept, meaningful men’s engagement in gender-transformative approaches continues to be critical. If men continue to view women’s decisions as restricted to “acceptable” domains, efforts to improve women’s autonomy will be limited. Interventions must actively engage men in conversations about power, gender roles, and decision-making rather than assuming that structural changes alone will shift attitudes. Programs should challenge deep-seated notions of masculinity that equate decision-making power with male identity.

4.5. Community-Led Approaches for Structural Change

Since household decision-making norms are embedded within broader social and cultural structures, community-led approaches that involve religious leaders, elders, and local institutions may be more effective than individual-focused interventions. Programs should frame gender equality in a culturally relevant way, ensuring that shifts in decision-making power are perceived as beneficial rather than threatening.

4.6. Integrating Gender Norms into Education and Socialization

The lack of association between education and men’s gender role perception suggests that curriculum-based gender awareness programs need to be strengthened. School and community-based interventions should emphasize gender-equitable decision-making beyond traditional role assignments.

4.7. Revisiting How We Measure Women’s Decision-Making Autonomy

Current measures of autonomy must move beyond simply asking whether women make decisions to interrogate why those decisions are being made, who grants that decision-making space, and whether women feel free to make decisions across all domains of life.
A major strength of this study is its focus on men’s perceptions of women’s independent decision-making, which provides a novel perspective on women’s decision-making dynamics in MNCH. By centering on men’s reasoning, this study highlights how women’s independent decision-making may not always indicate actual shifts toward gender equality. However, some limitations should be noted. The study relied on self-reported perceptions, which may be subject to social desirability bias. Additionally, while the sample provides valuable insights, qualitative research is needed to explore the underlying beliefs that shape men’s attitudes toward gender roles and decision-making. Furthermore, we acknowledge the limitation of not including women’s perspectives directly. Future research would benefit from relational and comparative approaches that include perspectives from both partners, offering a more comprehensive understanding of women’s autonomy and critically examining what joint decision-making really entails. Additionally, future studies should also examine whether perceptions of women’s decision-making autonomy translate into actual shifts in gender power dynamics over time.

5. Conclusions

This study challenges us to rethink the ways in which we interpret women’s decision-making in patriarchal contexts. It reveals that reported women’s decision-making autonomy in patriarchal settings often masks compliance with traditional gender roles rather than reflecting genuine empowerment. True gender equality is not just about increasing the number of decisions women make—it is about ensuring that their ability to make those decisions is recognized as a fundamental right rather than a gendered expectation. As public health professionals, policymakers, and researchers, we must ensure that our frameworks do not simply document decision-making but actively interrogate who holds power, who defines roles, and what autonomy truly means in a gender-transformative context. By addressing these deeper structural issues, we can move beyond surface-level autonomy and work toward a future where women’s decision-making is not confined to societal roles, but fully recognized as a reflection of their agency, capability, and rights. Gender-transformative interventions must go beyond increasing women’s participation to actively challenge the norms that dictate acceptable roles.

Author Contributions

The authors contributed to this manuscript in the following ways: conceptualization, R.T.; methodology, R.T., and N.C.M.A.; validation, N.C.M.A.; formal analysis, R.T.; writing—original draft preparation, R.T.; writing—review and editing, R.T., and N.C.M.A.; supervision, N.C.M.A. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the following small grants from the University of Iowa: Global Public Health Student Travel Grant, Graduate Student Success Award, Graduate and Professional Student Government, and the Department of Community and Behavioral Health.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the University of Iowa (ID# 202010039 on 11 November 2020). In addition, a permit/license was obtained from the National Commission for Science, Technology, and Innovation (NACOSTI), which is the local government agency responsible for research conducted in Kenya. Local IRB approval was not needed.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author due to the sensitive nature of the focus group discussion transcripts.

Acknowledgments

We express our gratitude to the group of dedicated data collectors and focus group participants from Kakamega County, Kenya.

Conflicts of Interest

The authors declare no conflicts of interest.

References

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Table 1. Descriptive statistics for all study variables.
Table 1. Descriptive statistics for all study variables.
Study VariablesnReason for Women’s Independent Decision-MakingReason for Men’s Independent Decision-Making
Equal and Capable of Deciding (n/280)It Was Woman’s Domain (n/280)Other Reasons (n/280)It Was Man’s Domain (n/280)Women Cannot Make These Decisions (n/280) Other Reasons (n/280)
who made the decision
 Women11332 (11.4%)78 (27.9%)3 (1.1%)---
 Men105---92 (42.2%)13 (6.0%)-
 Jointly6216 (5.7%)-46 (16.4%)-46 (16.4%)16 (5.7%)
Age
 18–242817 (6.1%)11 (3.9%)-11 (3.9%)16 (5.7%)1 (0.4%)
 25–34453 (1.1%)42 (15.0%)-29 (10.4%)15 (5.4%)1 (0.4%)
 35–4910935 (12.5%)59 (21.1%)15 (5.4%)73 (26.1%)35 (12.5%)1 (0.4%)
 50+9826 (9.3%)62 (22.0%)10 (3.6%)74 (26.45%)22 (7.9%)2 (0.7%)
Ethnicity
 Luhya25678 (27.9%)155 (55.4%)23 (8.2%)180 (64.3%)71 (25.4%)5 (1.8%)
 Other243 (1.1%)19 (6.8%)2 (0.7%)17 (6.1%)7 (2.5%)-
Family size
 Small (1–3)7114 (5%)52 (18.6%)5 (1.8%)53 (18.9%)17 (6.1%)1 (0.4%)
 Medium (4–6)14140 (14.3%)86 (30.7%)15 (5.4%)101 (36.1%)37 (13.2%)3 (1.15)
 Large (7+)6827 (9.6%)36 (12.9%)5 (1.8%)43 (15.4%)24 (8.6%)1 (0.4%)
Education
 No education111 (0.4%)10 (3.4%)-6 (2.1%)3 (1.1%)2 (0.7%)
 <high school17257 (20.4%)97 (34.6%)18 (6.4%)123 (43.9%)46 (16.4%)3 (1.1%)
 High school388 (2.9%)26 (9.3%)4 (1.4%)25 (8.9%)13 (4.6%)-
 Associate degree+5915 (5.4%)41 (14.6%)3 (1.1%)43 (15.4%)16 (5.7%)-
Religion
 Traditional2611 (3.9%)12 (4.3%)3 (1.1%)17 (6.1%)8 (2.9%)1 (0.4%)
 Catholic5015 (5.4%)32 (11.4%)3 (1.1%)35 (12.5%)15 (5.4%)-
 Protestant17749 (17.55)112 (40%)16 (5.7%)124 (44.3%)50 (17.9%)3 (1.1%)
 Muslim276 (2.1%)18 (6.4%)3 (1.1%)21 (7.5%)5 (1.8%)1 (0.4%)
Wealth rank
 Low9532 (11.4%)55 (19.6%)8 (2.9%)68 (24.3%)24 (8.6%)3 (1.1%)
 Middle9222 (7.9%)62 (22.1%)8 (2.9%)64 (22.9%)27 (9.64%)1 (0.4%)
 High9327 (9.6%)57 (20.4%)9 (3.2%)65 (23.2%)27 (9.4%)1 (0.4%)
Table 2. Adjusted odds ratios (AOR) for the association between women’s independent decision-making and gender role perception (N = 218).
Table 2. Adjusted odds ratios (AOR) for the association between women’s independent decision-making and gender role perception (N = 218).
Women’s Independent Decision-MakingAORStd. Err.zp > |z|[95% Conf. Interval]
Gender Role Perception *
Equal and capable of decision-making1-----
The decision was woman’s domain4.402.154.240.002.485.78
Some other reasons0.310.23(1.56)0.120.071.34
Age (Years)
18–245.544.554.770.005.087.27
25–348.525.493.320.012.419.15
35–494.421.773.720.002.029.69
50+1-----
Education
No formal education 2.232.870.620.530.172.78
Less than high school1.600.790.950.340.614.21
High school1.130.740.200.840.324.05
Associate degree+1-----
Religion
Traditional1.110.740.150.880.294.14
Catholic1.540.780.840.390.574.17
Muslim2.952.130.150.130.7212.12
protestant1-----
Family size
Small (1–3)1-----
Medium (4–6)0.520.24(1.44)0.150.231.27
Large (7+)0.820.43(0.37)0.710.292.30
Wealth rank
Low1-----
Middle0.810.36(0.48)0.630.341.92
High1.040.500.100.920.412.68
* Men’s reasons why women made independent decisions.
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Tura, R.; Aluku, N.C.M. Whose Decision Is It Anyway? Men’s Perceptions of Women’s Decision-Making Autonomy in Maternal and Child Health in Western Kenya. Soc. Sci. 2025, 14, 452. https://doi.org/10.3390/socsci14080452

AMA Style

Tura R, Aluku NCM. Whose Decision Is It Anyway? Men’s Perceptions of Women’s Decision-Making Autonomy in Maternal and Child Health in Western Kenya. Social Sciences. 2025; 14(8):452. https://doi.org/10.3390/socsci14080452

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Tura, Robsan, and Nema C. M. Aluku. 2025. "Whose Decision Is It Anyway? Men’s Perceptions of Women’s Decision-Making Autonomy in Maternal and Child Health in Western Kenya" Social Sciences 14, no. 8: 452. https://doi.org/10.3390/socsci14080452

APA Style

Tura, R., & Aluku, N. C. M. (2025). Whose Decision Is It Anyway? Men’s Perceptions of Women’s Decision-Making Autonomy in Maternal and Child Health in Western Kenya. Social Sciences, 14(8), 452. https://doi.org/10.3390/socsci14080452

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